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So Many Medical Bills...

I do have health insurance, but, after seeing all my medical bills piling up, I discovered my insurance doesn't cover most of it. Does anyone else have this problem? Thank goodness I don't have to see my doctor anytime soon. I used to see them every month. :shock: Lupus can be very expensive with all the bloodtests, urine tests, different doctors to see... :crazyeyes: Medicines to take... The doctors that I have now: a rheumie and a nephrologist were referred to by my primary MD(who's covered under my insurance-thank goodness). Should I change my dr's to ones who take my insurance? At least the office visits will be covered? Right? How about all the tests? Need some advice from you guys. Because I'm realizing that I can't afford this illness anymore. :cry:

"I've learned that when bad times come, you can let them make you bitter or use them to make you better."

Hi Buddha

Hi BuddhaBelly,

ABSOLUTELY.....is my answer to changing doctors that accept your insurance. I fully understand what you mean about medical bills; I have a rheumatologist, nephrologist, cardiologist, pulmonary, speech therapy, cognitive therapy....and physical therapy. I am on a weekly basis with all of them! So take heart, and understand this; please don't compromise your health to save a few dollars !! You are precious to so many....and the bills will be paid in time. After having been in the hospital 4 times this past year, I threw my hands up and I decided that it's not worth getting all stressed out over; so I do what I can and know that I'm doing the best I can every day.

STRESS is the single worst thing for lupus.....next to sun and everything else (smile); Do as much as you can do for yourself, and accept that paying these bills, meds, etc., is like having to pay the electric bill, or mortgage....it's a necessity!

So I'm glad you felt like you could vent, do you feel better now ? (smile)

Take Care
Browneyedgirl

p.s. I'm signing off for now - my CRP is at 7.5 today - feelin' pretty bad today - so I'm off for a nap!! Talk to you soon. Cheer up BuddhaBaby, you are loved !!

Is there a specific reason why the bills aren't covered?

If you have insurance, the company has to tell you why a specific service or bill isn't covered. With a lot of insurers, you can only use doctors within their specific network, so it pays to check beforehand. Many companies have websites which list participating providers. If you need to see a particular specialist who isn't in your network, try contacting your insurance company for permission to go out of network. I have done this several times because there are few specialists in my area.

If you have a very serious or chronic condition, many insurance companies have case managers they will assign to work directly with you to coordinate your medical care. This can be good because you can deal with one person, who may be willing to work the system on your behalf. If a bill was denied that you think should have been paid, appeal! Don't be afraid to ask your doctor's billing office for help - they have a vested interest in getting your insurance to pay up.

As for hospital bills, most hospitals have financial assistance programs you may qualify for , so be sure to ask. Most hospital social workers are very knowledgeable about what kind of help might be available. If you are having problems getting your meds, check out the Parternership for Prescription Assistance website - you may be able to get meds free or much cheaper. I know how stressful the medicals bills can be - my last hospitalization was almost four months long, with 2 weeks in ICU. i stopped worrying about the totals a long time ago, if I ever sat down and totalled up all my bills from the past six years, I'd probably have a heart attack. Do the best you can, and try to find as much help as possible.

I understand all to well. We had insurance up until last Dec. when my husband was no longer needed at his employer. Now we have nothing, it all costs so much. Thank goodness that my Rheumy gives me some samples. Rx's is what can get you, thank God for generic meds. and he gives me a 20% discount. Blood work is what costs so much, so if he does have to take blood I usually have to pay that out.
If insurance didn't cost so much for our family, it is about the same as our house payment for a family of five.
Good luck and I hope that you will find what is best for you.

JESSICA, IF YOU DO NOT HAVE DRUG COVERAGE, CHECK OUT THE PPA

COPIED FROM THEIR WEBSITE - PPARx.org - or call 1-888-4PPA-NOW - YOU MIGHT BE ABLE TO GET AT LEAST SOME OF YOUR MEDS FREE. THIS IS A LEGIT ORGANIZATION AND DEFINITELY WORTH CHECKING IN TO.

The Partnership for Prescription Assistance brings together America's pharmaceutical companies, doctors, other health care providers, patient advocacy organizations and community groups to help qualifying patients who lack prescription coverage get the medicines they need through the public or private program that's right for them. Many will get them free or nearly free. Among the organizations collaborating on this program are the American Academy of Family Physicians, the American Autoimmune Related Diseases Association, the Lupus Foundation of America, the NAACP, the National Alliance for Hispanic Health and the National Medical Association. To access the Partnership for Prescription Assistance by phone, you can call toll-free, 1-888-4PPA-NOW (1-888-477-2669).

I looked this up once and I thought it was for people over 50. I'm 36, I have checked into the merck program but my doctor said there wasn't anything that was being offered free that I could take that was on their medicine list. I was hoping that plaquenil was on some program but when I looked it up it is a med.from France ???? and I didn"t see any discount meds. on that website.
Thanks for thinking of me .

Thanks for all the helpful replies. I'm trying not to stress myself out with all the medical bills. Thank goodness, my insurance covers my medication, at least. But everything else like the bloodtests, my kidney biopsy, urine tests, wasn't covered at all. Is there health insurace that covers these tests?? I have a dermatologist, rheumatologist, and a nephrologist. My derma is in my insurance plan, but the other two arent. I'm not sure how my insurance works, but, if I find specialist dr's listed in my network, will I only have to pay for my copay? Because right now, my rheumie isn't in my network, and his office is giving me a discount because of it, I pay for the office visit each time I go. Still costs a lot of $$.

Gosh, I apologize for all my questions. I need all the help I can get. Thanks again for the replies. I really appreciate it.

"I've learned that when bad times come, you can let them make you bitter or use them to make you better."

Buddhabelly - about insurance

If your insurance is through your job, the benefits manager at your employer should have a members' handbook or manual that lists all covered services. If you buy your insurance directly, call the company and ask for a list of covered services and any exclusions (things your insurance won't cover). Most insurance companies will cover laboratory tests like blood tests if they are ordered by a doctor who's in your network. If the doctor is out of network, many companies won't pay for tests ordered by that doctor. Your insurance company may also want you to use a specific lab for tests.

If you have to use a specialist who is out of network, get your network doc to order the tests and send copies to the other docs. That way the insurance should pay. If you use a specialist who is in network, you should only have to pay the co-pay amount. Be aware the specialist co-pay is usually higher. Also, many insurers have strict policies about seeing specialists. You may need a referral from your PCP, and there may be a limit on how often you can see a particular specialist. Just be sure you know your particular insurer's rules.

If the kind of specialist you need isn't available in your network, the insurer will generally let you go to the nearest available specialist regardless of network, but you do have to get permission from the insurance company in advance.

Remember you always have the right to appeal any decision by the insurance company about your coverage. Most insurance companies have a person called an ombudsman whose job is to resolve complaints. If a number of your claims have been denied and you don't know why, this is the person to contact. If you think you have been treated illegally or unfairly, contact your state insurance commission for help. All states have statutes and regulations about how insurance companies do business - and those laws are to protect you.

I guess the main thing is don't be afraid to ask questions and demand answers. If you have been hospitalized, or had a number of tests done, always ask for an itemized bill and review it to make sure you weren't charged for things you never got. On my last hospital bill, I was charged over $1,000 for I.V. gentamycin, which I know wasn't mine because I'm extremely allergic to it, and it's on
my medical records, so the hospital had to delete the charge. Stuff like that happens all the time, so you have to be careful to check your bills.